Introduction
Patients with an underlying urological diagnosis colonised with multidrug-resistant organisms (MDRO) such as ESBL are predisposed to recurrent UTIs. In FMT, healthy donor stool is administered into the GI tract to restore healthy gut microbiota. This is acknowledged as an effective treatment for recurrent Clostridium difficile infection, and now as an emerging method of eradicating MDROs. There are little data reporting on its therapeutic value in Urology.

METHODS

Retrospective analysis of culture positive urine isolates was obtained from 2015-2018 at a tertiary level service. Clinical profiles of patients with recurrent ESBL UTIs was performed. Four patients who had ESBL UTIs underwent FMT.

Results
From June 2015-January 2018, 2059 patients under Urology services had a positive urine culture. 128 (6%) were ESBL. 456 patients had multiple positive urine cultures. Of these, 62 (14%) had multiple ESBL UTIs, constituting 8% of recurrent ESBL UTIs in the trust (806 total). 52/62 (84%) with recurrent ESBL UTIs had underlying urological diagnoses; 10/62 (16%) were purely managed for recurrent UTIs. 19/62 patients had >1 underlying diagnosis. 7/62 (11%) had urological reconstruction. 40/62 (65%) had prosthetic devices in situ (Table 1). Four patients received FMT, Table 2 describes their outcomes.

Conclusions
ESBL UTIs are highly prevalent in Urology. Underlying causes should be investigated, due to high incidence of obstructive aetiologies. Our early experience of FMT for decolonisation and prevention of transition to infection with MDROs has shown FMT to be safe, well tolerated and effective.